To quote my original "second opinion" Pulmonologist,
Dr. William Figueroa, you get one by being sick enough to need it but healthy
enough to withstand it. It is, as he so eloquently put it, a "finesse
move".

Generally speaking, the process of receiving a
lung transplant goes like this:

1. First, you are referred to a lung
transplant center, either by your Pulmonologist, General Practitioner,
or by your own direct request. It is of utmost importance that this
referral be made as soon as possible for many reasons--time is the enemy,
respiratory disease is often unpredictable, and patients are at great risk
for opportunistic infections that can be deadly.

2. Next, you are evaluated and (hopefully)
accepted by a lung transplant center. The process of evaluation varies
from center to center and from patient to patient, but basically consists
of approximately three days of testing at the center. These tests
include allergy tests, blood tests (18 vials at last count), Pulmonary
Function Tests (PFTs), arterial gas test, psychological tests, lung perfusion
tests, echocardiogram, heart catheterization, psychological and sociological
interview, financial analysis, a stress test, the infamous six-minute walk,
and others as dictated by the specific disease and/or physical condition
of the patient. Acceptance generally follows successful completion
of these tests.

3. Upon acceptance into a lung transplant
program, you are placed on a waiting list. IPF patients receive a
90-day credit upon acceptance, but others start from the day they are officially
accepted. You will at this point typically receive a complimentary
beeper courtesy of a participating paging service.

4. As time passes, you "move up the
list" in categories of size and blood type until such time as you are at
the top of the list for the size and blood type of a donor organ when it
becomes available. This can take anywhere from approximately two
weeks to one-and-a-half to two years or more. You hear stories of
two-week waits, but they are the exception. Typical waiting list
averages are a little over over one year at small centers and about two
years and change at larger, well-known centers. Having a common blood
type means you are competing against a lot of other candidates, but also
will be eligible for more donor organs. In contrast, having a rare
blood type means fewer eligible donor organs, but less competition for
them, so generally this situation is described by most centers as "a wash".
It works the same way for size.

5. Assuming you can withstand the
wait and don't get delisted due to any number of conditions considered
by the transplant center to be disqualifying factors, eventually you are
beeped and/or telephoned by the center and told that a donor organ is available.
If you are hospitalized at this point, you may be transplanted in-place
or med-evacuated to the transplant center. If you are still at home,
you will generally be ambulanced to either the transplant center or to
a heliport and then med-evacuated by helicopter to the center. Much
concern is focused on this part of the process, but the transplant center
will usually take care of all transportation arrangements, although they
may not do the best job of explaining it to you beforehand.

At this point, you are firmly in the hands of the
medical team you chose way back when. How things turn out depends
on how they do, and how you do from this point on.